Fragmentation targeted at preferred discontinuities: A new concept in endolithotripsy with Holmium laser:YAG

Abstract Introduction There are currently 3 holmium laser, YAG (Ho:YAG) endolithotripsy procedures that are considered basic (fragmentation, pulverization, “pop-corn” technique). We present the technique of fragmentation targeted at preferred discontinuities (FTPD), a new concept of endolithotripsy by Ho:YAG laser. Material and methods The FTPD technique is based on the selective application of energy (targeting a specific preselected point) to an area that is visually prone to the formation of a fracture line or preferred discontinuity (conditioned by the anisotropy of the urolithiasis). The ideal energy regimen (setting) is a high range of working energy (2–3 J) with a very low frequency range (5–8 Hz) and short pulse width. Between January 2015 to February 2017, the FTPD technique was used in 37 procedures (7 NLP, 16 RIRS, 12 URS, 2 cystolithotomies), with a Ho:YAG laser (Lumenis Pulse 120H ® , Tel-Aviv, Israel). Maximum power used: 24 W (3 J/8 Hz) with fibers of 365 μ and 273 μ (URS, RIRS), and 32 W (4 J/8 Hz) with fibers of 550 μ (NLP, cystolithotomy). Results Strategic improvement was achieved in all cases using the TFPD technique to continue the endolithotripsy or remove fragments. No complications were recorded after the use of this method. Conclusions FTPD can be considered a complementary option in combination with the basic methods of fragmentation and pulverization. In our experience, it constitutes significant progress in optimizing the performance of Ho:YAG laser endolithotripsy.